Congestive Heart Failure (CHF) is defined as a clinical syndrome in which the heart fails to propel blood forward normally, resulting in congestion in the pulmonary and/or systemic circulation and diminished blood flow to the tissues due to reduced cardiac output. (Berkow, M.D.) The result is that the heart does not pump enough blood to meet the body’s needs. CHF can be caused by a variety of conditions that affect the heart such as: diseases or substances that weaken the heart muscle such as heart attacks, infections, or toxins; diseases that cause stiffening of the heart muscle such as hemochromatosis, amyloidosis, coronary artery disease, and long term hypertension; and diseases that increase the oxygen demand by the body tissue beyond the capability of the heart to deliver oxygen-rich blood as in hyperthyroidism or anemia. (Kulick, M.D., and Shiel Jr., M.D.) CHF can affect many different organs including the heart, lungs, liver, intestines, and subcutaneous tissues. Symptoms of CHF are widely varied but may include fatigue, edema especially of the ankles and legs, shortness of breath with minimal exertion, and inability to lay flat due to reduced respiratory capacity. Increased urination may occur, especially at night, and due to accumulations of fluid in the liver and intestines nausea, abdominal pain and decreased appetite may result. (Kulick, M.D., and Shiel Jr., M.D.) Although CHF is an equal opportunity disease, there are some differences noted between men and women, one of which is that women tend to develop CHF later in life than men. Women more frequently develop diastolic heart failure rather than systolic. Women often suffer more noticeable shortness of breath and swelling of the ankles than do men, and in general, women survive CHF longer than men. (Starling, M.D.) Treatments for CHF can vary and involve medication(s), surgery, insertion of heart assist devices, and lifestyle changes. Often treatment is directed at the underlying condition as mentioned above, or may be directed at treating the symptoms of CHF such as the edema.
The ICD-9-CM categorizes Congestive Heart Failure into subcategories based on side of heart involved and whether systolic or diastolic as defined below, with some of the subcategories further divided into subclassifications based on whether the heart failure is acute, chronic, acute on chronic, or unspecified:
• 428.0 Congestive heart failure, unspecified
Right heart failure
Mechanical inadequacy; caused by inability of heart to pump and circulate blood; results in fluid collection in the lungs, hypertension, congestion, and edema of tissues. (Hart, RHIA, CCS, CCS-P, Stegman, MBA, CCS, and Ford, RHIT, CCS)
• 428.1 Left heart failure
Mechanical inadequacy of left ventricle; causing fluid in lungs. (Hart, RHIA, CCS, CCS-P, Stegman, MBA, CCS, and Ford, RHIT, CCS)
• 428.2x Systolic heart failure
Heart failure due to a defect in expulsion of blood caused by an abnormality in systolic...